Strengths and Limitations
An acknowledged strength of this study is that the PRISMA statement was
adhered to and a comprehensive literature search according to the AMSTAR
criteria conducted. A large scope of evidence was available and
retrieved from Embase, Medline and the Cochrane Database of Systematic
Reviews. An identified limitation is that the review authors who
assessed the quality of the studies were aware of the journal of
publication and authorship of the study. However, the potential for bias
was minimized by having two independent review authors reach a consensus
for each AMSTAR criteria. Another limitation involves the relatively
small sample size of included studies (n=48). With a greater number of
studies published in this area of research, new trends regarding
methodological quality and publication details may emerge. Furthermore,
the comparison between AMSTAR score and the number of citations may be
affected by publication date of the systematic review; those recently
published will not have accrued as many citations as older publications,
even though they may have higher AMSTAR scores. However, we have chosen
to utilize this metric as it may provide insight to how the
methodological quality of the publication has affected current
policymaking.